Provider Demographics
NPI:1376295329
Name:SHEPLER, JORDYN NICOLE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JORDYN
Middle Name:NICOLE
Last Name:SHEPLER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37788 CHASE CT
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-5040
Mailing Address - Country:US
Mailing Address - Phone:313-350-5396
Mailing Address - Fax:
Practice Address - Street 1:19809 FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1444
Practice Address - Country:US
Practice Address - Phone:248-880-0077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-21
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501021688225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist